HomeMy WebLinkAboutApplication and VOC electricAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L-? CAL.._ .
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 40 x soi +d I n
PROPOSED IMPROVEMENT LOCATION:
Address: `�" l !D5 -_). I nC1 I CLx1 K 1V_e C I. C. LCY-t- I`w eY_-C1i I
Property Tax ID #: ZLA _�)U - -I Q 2. - 000 2- - 0 QQ -
Lot No.
Site Plan Name: Block No.
Q
Project Name: r :) hC)
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
Electric _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: z 00C� ) Sq. Ft. of First Floor: Won
Cost of Construction: $ �(-0 3 S) L� Utilities: — Sewer X Septic Building Height: I 1 . s
OWNERAESSEE:
CONTRACTOR:
Name Ed-ul Bohn
Name:
I n
Address:: I 0Q0 500+h I a i L! S VQ�4 S\A1
Company: QCk. Q Y>
City: V e-r-C-) e�ffaC}-) State: FL
4
Zip Code: �� 9 (D O Fax:
Phone No. qN-- 3_ S - ao,3a E-
--
Address: �6 N VJ R-I YY O
V I�Q
City: Rxcta L LL.CJ e- _
Zip Code: 34983 Fax:
Phone No 77a -340 -7a a3
State:
Mail:
Fill in fee simple Title Holder on next page {if different
from the Owner listed above)
E-Mail ad m i n P aCL a
home - a Gam
State or County License C6
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: me -Donn Cth
Address: 2.ULA r.JA1eri6ne OCL-
MORTGAGE COMPANY:
Name: Flora eL
Address:_1-11 tJW &[.Lucia
Not Applicable
We5,:+ I
city: Le_'x nokinn State: ::ic
City: o q- Lucite
State: r
Zip: ?_ 1 0T7_ Phone R (C-L -1tu -
Zip::34g 8:3 Phone:
?-7a-3atl -- 1019 --
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
�G Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an c work or recording our Notice of Commencement.
i
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA c� La
�`.
COUNTY OF C..L _
Sworn to (or affirmed) and subscribed before me of >0 Physical Presence or Online Notarization
this,'-5-day of r) 20]� by
Amreld r In
Name of person making statement.
in
Personally Known (' OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
�% Paula S. Breier
ll��J�,/��
Commission No,/!T` W !�7 �
Comm.#HH437951
(Seal)
•:~oF Aaron
Bp11 W ThN
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
PERMIT # ISSUE DATE
COUNTY
F
L
0 R
I 0 A
Ed's Electric, Inc.
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the electrical Sub -contractor for Pace 2000, Inc.
(Type of Trade)
For the project located at
_q55 S. in,
(Primary Contractor)
River Er. J 21Wy 4 -`T 02- woz -q
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACTOR SIGNATURE ((qualifier)
Andrew Nadalin
PRINT NAME
CBC059859
COUNTY CERTIFICATION NUMBER
State of Florida, County of St Lucie
The foregoing instrument was signed before me this ✓ day of
Jalnua 20 k, r !rn
who is personally known Y or has produced a
as i ntifieatiom
r.
Signature of Notary Public
Paula S. Breier
Print Name of Notar-* Pu blic
ON" Paula S. Breier
~�N Comm.#HH037951
., Expires: SepL15, 2024
Boltded Tivu Am Notary
Revised 11/16/2016
SUBCONTRACTOR SIGNA�cr)
Edward June
PRINT NAME
ECO001569
COUNTY CERTIFICATION N WMER
State of Florida, County of St Lucie
The foregoing instrument was signed before me this 5 day of
Jnhlaaru ,7o_2Lby sward .1i_)►ne_
who is personally known �O or has produced a
as identiScatiom
STAMP AkL& S.
Signature of Notary Puubli
Paula S. Breier
Print Name of Notary Public
Paula S. Breier
' Comm.#HH037951
I DOM: S* 15. 2024
B-nded Thru AM N01ary
STAMP